Citation Nr: 0613055
Decision Date: 05/04/06 Archive Date: 05/15/06
DOCKET NO. 02-18 523 ) DATE
)
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On appeal from the
Department of Veterans Affairs Regional Office in St.
Petersburg, Florida
THE ISSUE
Entitlement to a compensable rating for psoriasis.
ATTORNEY FOR THE BOARD
D. Vella Camilleri, Associate Counsel
INTRODUCTION
The veteran served on active duty from January 1975 to
January 1977 and from July 1979 to July 1997.
This matter is now before the Board of Veterans' Appeals
(Board) pursuant to a June 1998 rating decision by the St.
Petersburg, Florida, Regional Office (RO) of the Department
of Veterans Affairs (VA). Appeal to the Board was perfected.
FINDING OF FACT
The veteran's service-connected psoriasis involves less than
5 percent of his entire body and exposed areas, does not
require intermittent systemic therapy such as corticosteroids
or other immunosuppressive drugs, and was not manifested by
exfoliating, exudation, or itching on an exposed surface or
extensive area before August 2002.
CONCLUSION OF LAW
The criteria for a compensable rating for service-connected
psoriasis have not been met. 38 U.S.C.A. § 1155 (West 2002);
38 C.F.R. § 4.118, Diagnostic Code 7816 (2005), Diagnostic
Code 7806 (2002).
REASONS AND BASES FOR FINDING AND CONCLUSION
Disability evaluations are based upon the average impairment
of earning capacity as determined by a schedule for rating
disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part
4 (2005). Separate rating codes identify various
disabilities. 38 C.F.R. Part 4. In determining the current
level of impairment, the disability must be considered in the
context of the whole recorded history, including service
medical records. See generally 38 C.F.R. §§ 4.1, 4.2 (2005).
Service connection for psoriasis was granted with a
noncompensable evaluation assigned under 38 C.F.R. § 4.118,
Diagnostic Code 7816, effective August 1, 1997. See December
1997 rating decision. The veteran appealed the June 1998
rating decision that continued the noncompensable rating.
During the appeal, the rating criteria for skin diseases were
amended, effective August 30, 2002. Prior to the amendments,
psoriasis was to be rated as eczema pursuant to old
Diagnostic Code 7806 (2002). A 10 percent evaluation was
warranted for eczema with exfoliation, exudation or itching,
if involving an exposed surface or extensive area. New
Diagnostic Code 7816 (2005) now has its own rating criteria.
A 10 percent evaluation is assigned for psoriasis that
affects at least five percent, but less than 20 percent, of
the entire body, or at least five percent, but less than 20
percent, of exposed areas affected, or; intermittent systemic
therapy such as corticosteroids or other immunosuppressive
drugs required for a total duration of less than six weeks
during the past 12-month period.
The evidence of record does not support a compensable
evaluation under either the old or new rating criteria for
psoriasis. Prior to August 30, 2002, the veteran was
diagnosed with tinea pedis, scaling type, on both soles;
onychomycosis of the left great toenail; and dermatophytosis
of the right 4-5 interspaces. See February 1998 VA
compensation and pension (C&P) skin diseases examination
report. The external auditory canals of both his ears were
found to be somewhat flaky in April 1999, consistent with
eczematoid otitis externa, and he was started on Valisone
lotion to treat the eczema. There is no evidence to suggest,
however, that any of these conditions, in particular the
eczematoid otitis externa, involved an exposed surface or
extensive area, or any exudation or itching, so as to warrant
a 10 percent evaluation under the old rating criteria.
Since August 30, 2002, and the inception of his appeal, the
veteran has undergone two VA C&P examinations. In November
2004, the veteran reported the breakout of a rash on his
knuckles and feet causing his skin to become cracked and dry
and to bleed. He indicated that he had tried creams and
pills, and had probably tried steroid lotions, but was then
only using Vaseline Intensive Care. The veteran reported
that the rash never really went away and got worse once or
twice a month, at which time he increased the amount of
lotion he used, changed his clothes more often, and decreased
the frequency of washing his hands and feet. The VA examiner
noted that the veteran had a questionable history of steroid
usage, but had never had light or immunosuppressive therapy.
The examiner also noted that the rash only covered a few
knuckles and his big toes, occupying less than one percent of
the veteran's total body surface area.
In November 2005, the veteran reported that cracked skin
becomes crusty and bleeds every 10 days, varying in location
from the ears to the hands and lasting for three to four
days. He indicated that he uses lotions, ear drops, and
steroid creams (which he has been using for the past two
years), which clear his psoriasis after he treats it for
three to four days. Upon physical examination, some areas of
redness with some scaly skin were found on the right hand
knuckles and the first interphalangeal joints from fingers
two through five. No breakage of the skin or bleeding was
noted and the condition occupied less than one percent of the
total body surface area and one percent of the exposed area.
An area of redness with scaling of the skin was also noted on
the left hand, from the second through the fifth finger on
the knuckles and the first interphalangeal joint. No
breakage of the skin or bleeding was noted and the condition
was found to occupy one percent of both the total body
surface and exposed area. Dry skin was also noted in both
ears extending from the inferior aspect of the ear to the
middle ear. There was no obvious bleeding noted and the
condition was found to occupy less than one percent of the
total body surface area and approximately less than one
percent of the exposed area. The veteran's big toenails
showed psoriatic nails, the left more prominent than the
right. The condition occupied less than one percent of the
total body surface area and less than one percent of exposed
area. The VA examiner opined that the current level of
severity is mild and that although the disease is active, it
appears to come and go and seems well-controlled with
medication.
During neither VA C&P examination was the veteran found to
suffer from psoriasis that affects at least five percent, but
less than 20 percent, of the entire body, or at least five
percent, but less than 20 percent, of exposed areas affected.
Nor is there any indication that he has been prescribed
corticosteroids or other immunosuppressive drugs to control
his psoriasis. Although the veteran contends that he has
been on steroid medication for the past two years, a review
of the claims file reveals that the only medication
prescribed to the veteran related to his skin was
erythromycin 2% topical gel for facial lesions. See
September 2000 nursing note. There is also no record to
suggest that the veteran continued using Cyclocort cream, a
topical corticosteroid, after it was prescribed to him during
service. See December 1996 health record. As such, a
compensable rating is not warranted.
VA's duties to notify and assist claimants in substantiating
a claim for VA benefits are found at 38 U.S.C.A. §§ 5100,
5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005);
38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2005).
Upon receipt of a complete or substantially complete
application for benefits, VA is required to notify the
claimant and his or her representative, if any, of any
information, and any medical or lay evidence, that is
necessary to substantiate the claim. 38 U.S.C.A. § 5103(a)
(West 2002 & Supp. 2005); 38 C.F.R. § 3.159(b) (2005);
Quartuccio v. Principi, 16 Vet. App. 183 (2002). In
accordance with 38 C.F.R. § 3.159(b)(1), proper notice must
inform the claimant of any information and evidence not of
record (1) that is necessary to substantiate the claim; (2)
that VA will seek to provide; and (3) that the claimant is
expected to provide. Proper notice must also ask the
claimant to provide any evidence in his or her possession
that pertains to the claim. Notice should be provided to a
claimant before the initial unfavorable agency of original
jurisdiction (AOJ) decision on a claim. Pelegrini v.
Principi, 18 Vet. App. 112 (2004).
The veteran's appeal originates from a June 1998 rating
decision which continued a noncompensable disability
evaluation for service-connected psoriasis following an
examination scheduled by VA. The issue was remanded in
December 2003 and July 2005 in order to effect compliance
with the duties to notify and assist. Specifically, the
Board determined that further evidentiary development was
needed in the form of obtaining pertinent medical records and
affording the veteran an appropriate examination.
Pursuant to the remands, the veteran was advised of the
necessary evidence to substantiate his claim; that the RO
would assist him in obtaining additional information and
evidence; and of the responsibilities on both his part and
VA's in developing the claim. See March 2004 and November
2004 RO letters. Prior to the second remand, the veteran was
also advised of the need to provide any evidence in his
possession pertinent to the claim. See April 2005
Supplemental Statement of the Case (SSOC). As such, VA
fulfilled its notification duties. Quartuccio, 16 Vet. App.
at 187.
The Board acknowledges that the veteran was not provided with
section 5103(a) notice concerning the evaluation of his
service-connected psoriasis until after the rating decision
that is the subject of this appeal. The current section
5103(a) notice requirements were not in effect, however, when
the June 1998 rating decision was issued. The veteran has
since been provided with appropriate notice. Moreover, as
the claim for service connection for psoriasis was
substantiated years before the section 5103(a) notice
requirements became effective, the veteran has not been
prejudiced by VA's failure to provide notice of all five
elements of a service-connection claim. See Dingess v.
Nicholson, No. 01-1917 (U.S. Vet. App. March 3, 2006)
(Hartman, No. 02-1506).
VA also has a duty to assist claimants in obtaining evidence
needed to substantiate a claim. 38 U.S.C.A. § 5103A (West
2002); 38 C.F.R. § 3.159 (2005). In this case, the veteran's
service medical, private, and VA records have been associated
with the claims file, and the veteran was afforded several VA
examinations in connection with his claim. In addition,
pursuant to the December 2003 remand instructions, the RO
attempted to ascertain from the veteran what medical
providers had treated him for a skin disorder, to include
tinea pedis. See March 2004 RO letter. No additional
evidence, to include information as to treatment for a skin
disorder, was submitted by the veteran and there is no
indication that he did not receive the RO's letter.
For the reasons set forth above, and given the facts of this
case, the Board finds that no further notification or
assistance is necessary, and deciding the appeal at this time
is not prejudicial to the veteran.
ORDER
A compensable disability evaluation for service-connected
psoriasis is denied.
____________________________________________
MARY GALLAGHER
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs